PACU
Location: University Hospitals - Cleveland Medical Center
Rotation Site Director: Angela Johnson, MD
Rotation Length: 4 Weeks
Welcome to your PACU rotation!
The overarching goal of the PACU rotation at is to offer an experience in the postoperative care of inpatients and outpatients recovering from a broad range of surgical procedures and anesthetics. During this rotation, residents learn to evaluate common PACU patient problems, understand how the PACU fits into the larger hospital structure, and develop skills in multitasking and management of multiple patients. Residents will also hone their skills to facilitate patient transfer of care from the OR, interpersonal skills, and professionalism when managing RN and patient family requests, and ultimately assessing patients for appropriate PACU discharge.
Residents are responsible for overseeing the general care of patients in the PACU including the assessment and management of postoperative pain, PONV, hemodynamic instability, advanced respiratory and airway management, as well a myriad of other emergency issues that may arise. They will be responsible for signing out patients who may need extra care to the on-call Mather attending at the end of their shift.
Educational goals include achieving proficiency in the management of common and uncommon post-anesthesia complications, understanding the roles of nursing and physicians in the care of postoperative patients, and understanding the criteria for phase I, phase II, and patient discharge.
As the center of the patient care team in the perioperative setting, an anesthesiologist is constantly interfacing with nurses, other physicians, respiratory therapists, support staff, and administrators who are all focused on facilitating patient care. Learning how to coordinate patient care with those teams as well as the medical knowledge, technical and decision-making skills with other teams is what exemplifies a consultant anesthesiologist.
Overall Rotation Goals:
To train residents to become capable in providing high quality evidence-based and compassionate PACU care
To develop an understanding of the physiological transition of a patient who has undergone anesthesia and will progress to phase II or discharge home
To be able to identify and manage common PACU problems such as postoperative pain, PONV, hemodynamic instability, advanced respiratory and airway management.
To understand how the flow of patients through the PACU can affect all levels of hospital function
To master the skill of providing and receiving patient handoffs
Recommended Resources and Articles
PACU Anesthesia Resident Rotation Goals
ASA Operating room design manual- PACU
Post-Anesthesia Care: Symptoms, Diagnosis and Management by Heitz
Postoperative Care Handbook of the Massachusetts General Hospital by Berg/Bittner
Anesthesia Toolbox- PACU Rotation Study Guide under the Tools tab
Resident Created PACU Summaries
Buprenorphine in the perioperative setting
Effect of alcohol use in the perioperative setting
Post-operative care for patient with obstructive sleep apnea (OSA)
Post-operative nausea and vomiting
Post-operative nausea and vomiting (2022)
Respiratory issues in the PACU
Assessments
Self-assessment
The resident will provide an evaluation of their experience and learning in the PACU before and after the PACU rotation in order to see their improvement
Compose a minimum 1 page review on an anesthesia or PACU related topic of your choice for contribution to the monthly PACU newsletter.
Summative written evaluation
The resident will receive a summative written evaluation form submitted by the faculty supervisors based on assessments filled by PACU nurses
Evaluations will be completed at the end of each week throughout the rotation as well as verbal feedback informally throughout the rotation
Verbal feedback
Informal verbal feedback will be provided to the resident
Case-logs
Case-logs will be evaluated semi-annually by the clinical competency committee for the number and type of procedures and anesthetic techniques entered to ensure they are obtaining adequate experience.